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Overactive thyroid

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Q Re the December 2001 issue of WDDTY (vol 12 no 9) on thyroid problems, I was very disappointed to find that most of the discussion was on hypothyroidism whereas I suffer from hyperthyroidism (a multinodular goitre)

Q Re the December 2001 issue of WDDTY (vol 12 no 9) on thyroid problems, I was very disappointed to find that most of the discussion was on hypothyroidism whereas I suffer from hyperthyroidism (a multinodular goitre).

Having considered carefully the conventional treatment options, I reluctantly decided to go on the drug carbimazole. I now suffer badly from joint pain and have put on unneeded weight.

Can you give me scientifically proven alternatives to conventional treatment for hyperthyroidism - or maybe even a case study on 'How I fixed my (overactive) thyroid without drugs?- PH, via e-mail

A Although hypothyroid problems usually get most of the attention, the thyroid can just as easily overheat. In that case, the gland governing your metabolic rate overproduces one or both of the thyroid's hormones. This sets your metabolism on hyperdrive, causing many of your body's functions to race.

As you know, antithyroid drugs are the most conservative means conventional medicine has of taming an overactive thyroid. Three drugs are commonly used: propylthiouracil, methimazole or carbimazole. All three inhibit thyroid hormone synthesis. Luckily, you have steered clear of methimazole, reputedly 10 times more potent than propylthiouracil.

Nevertheless, all three have substantial side-effects, the most worrisome of which are blood changes such as agranulocytosis, a sudden decrease in the number of white blood cells. This can cause extreme fatigue, fever and bleeding in the rectum, mouth and vagina. These drugs can also cause thrombocytopenia (reduced blood platelets), leukopenia (decreased white blood cells) and aplastic anaemia (a decrease in bone marrow ability to make white blood cells). With methimazole, there have even been reports of hepatitis and fatal liver disease.

As for carbimazole, manufacturer Roche warns that patients should be alert to the onset of sore throat, mouth ulcers, fever or other symptoms which might suggest bone marrow depression. In the event, it is important to stop taking the drug and seek medical advice immediately. Blood cell counts should be carried out, especially if there is evidence of infection.

Otherwise, this drug also causes nausea, joint pain, headache, mild gastric distress, skin rash and itching. Hair loss has been reported. Rarely, it can cause pancytopenia (a decrease in all types of blood cells) and myopathy (muscle and bone weakness). If you have had muscle pain with this drug, you should have your creatine phosphokinase levels regularly monitored (to see how well your muscles are working). Liver problems, such as jaundice, have also been reported.

You are sensible to want to try alternative therapies. So much evidence suggests that thyroid problems are due to an allergic or environmental cause that it seems sensible to remove those substances known to affect the thyroid to see if this corrects the condition before taking any medication.

Although it isn't clear why the thyroid gland begins to overwork itself, there are many environmental causes. As we've already identified in these pages (WDDTY, vol 7 no 7), the big-gest cause of the epidemic of overactive thyroid is iodised table salt. This well-meant act of adding iodine, needed to make thyroid hormones, is now responsible for epidemics of overactive thyroid in many parts of the globe.

In Galicia, in northwestern Spain, where iodised salt is mandatory, there is an abnormally high incidence of hyperthyroidism, particularly among women (J Endocrinol Invest, 1994; 17: 23-7). Other studies have shown that countries like the US and Japan, which have the highest intake of iodine, also have the greatest incidence of over-active thyroid problems.

Epidemiological evidence shows that iodised salt may cause overactive thyroid even where there is an iodine deficiency. In one study, the incidence of conditions heralding the development of hyperthyroidism rose to more than 30 per cent five years after iodine supplementation (J Clin Endocrinol Metabol, 1983; 57: 859-62).

It's also important that you avoid all the hidden sources of iodine, which is added to cough expectorants, antiseptics, certain drugs such as sulphonamide, lithium, dopamine, steroids, aspirin, the heart drug amiodarone and antidiabetic drugs, and even the contrast agents used for taking arteriograms or X-rays of organs like the kidneys. In one study of patients before and after receiving an angiogram with an iodine-containing contrast agent, a significant number of patients showed altered thyroid function for some weeks after the examination (Kardiologie, 2001; 90: 751-9).

Besides iodised salt, you should also remove other iodine-containing foods from the diet, such as kelp and Japanese seaweed. It's essential to avoid large doses of iodine in any form, as these will crank up the production and release of thyroid hormones (Nutr Health Rev, 1996; 75: 4). This includes any multivamin/mineral supplement containing more than 100 mcg of iodine per capsule.

A number of environmental chemical pollutants can also cause the thyroid to malfunction. Resorcinol, phthalates, metoxyanthracene, polybrominated biphenyls, cyanide (the concentrated byproduct of chemical fertilisers) and chlorinated compounds such as pentachlorophenol (a wood and leather preservative) have all been shown to significantly alter thyroid hormone production (N Engl J Med, 1980; 302: 31-3; Neurotoxicology, 1991; 12: 818).

If you drink tap or well water, you should change to another source of water immediately or have a reverse-osmosis unit fitted under your kitchen sink. Also, avoid drinking out of plastic bottles, which may contain phthalate esters.

If you are taking synthetic hormones such as the Pill or hormone replacement therapy (HRT), consider coming off, as oestrogen of any variety tends to make hyperthyroidism worse (Arzneim Forsch, 1961; 11: 92).

Studies have shown that patients with an overactive thyroid often crave and consume a high level of carbohydrates (J Clin Endocrinol Metabol, 2001; 86: 5848-53). In your case, it is preferable to consume high levels of protein and a high-calorie diet to help compensate for the high metabolic rate at which your thyroid is set.

You should also consume a number of uncooked 'goitrogenic' foods (foods that cause goitre, an enlarged thyroid, if eaten in excess), such as the brassica family (including broccoli, Brussels sprouts, cabbage, cauliflower, watercress and swede), millet and soya. These foods regulate thyroid function and lower iodine levels in an overactive thyroid (Therap Unschau, 1973; 30: 734). Aim to consume about a half a head of raw cabbage per day.

You should also avoid megadosing on vitamin C, the B vitamin PABA, amino acids cystine and glutathione, and iron, all of which also affect thyroid function. Large doses of iron can cause your body to treble its output of thyroid-stimulating hormone (TSH) (Ann Intern Med, 1992; 117: 1010-3).

If you regularly take any other herbs for other reasons, you may consider stopping as they may affect thyroxine production and absorption (Thyroidol Clin Exp, 1993; 6: 97-102).

If you are a smoker, you should quit as studies have shown a significant link between an overactive thyroid and tobacco smoking, particularly in those with eye problems (Acta Endocrinol, 1993; 128: 156-60).

Besides altering your diet and environment, you may also wish to try herbs with an excellent track record for treating overactive thyroid. Extracts of gypsywort (Lycopus europaeus) and bugleweed (L. virginicus) have good evidence of inhibiting iodine metabolism and thyroxine release (Wien Med Wochenschr, 1961; 31: 513). Be sure to opt for leaf extracts, which are more effective than root extracts (Arzneim Forsch, 1955; 5: 465).

Another herb with a natural antithyroid effect is motherwort (Leonurus cardiaca), which can reduce the palpitations and rapid heartbeat often associated with an overactive thyroid (Arzneim Forsch, 1961; 11: 830).

You might also wish to try traditional Chinese medicine (Trad Chin Med, 1985; 5: 19ff). In one study, acupuncture was given to 150 patients from an area of Romania considered one of the most polluted in Europe, where hyperthyroidism was thought to have resulted from heavy concentrations of lead, zinc and sulphur powders. Ninety per cent of the patients improved, and the usual clinical signs of overactive thyroid - palpitations, bulging eyes, irritability and insomnia - also improved or disappeared (J Br Med Acup Soc, 1994; 12: 67). The points needled included LI.4, ST.36, CV.17, LR.3, PC.6 and local points such as TE.13, LI.17 and CV.22.

Moxibustion, where a concentrated herb stick is slowly burned like a cigar over certain acupuncture points, has also helped in cases of thyroiditis (J Trad Chin Med, 1993; 13: 14-8).